RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00940
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Motor Transport Operator, medically separated for “chronic left knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention in their application.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20051004	VARD - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain 	5099-5003	10%	Left Knee Condition	5299	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI injured his left knee in September 2004, (4 months prior to separation).  Magnetic resonance imaging showed a torn anterior cruciate ligament (ACL) and medial meniscal tear.  At the time of surgery in December 2004 a torn ACL was repaired and there were no meniscal tears noted.  However, two weeks after surgery the CI twisted his knee and felt a “pop” and had increased pain and limited ROM.  Repeat MRI noted the ACL graft was intact and there were no meniscal tears noted again.  The CI was returned to the operating room in April 2005 for manipulation of the knee and use of the constant passive motion machine.  The knee was stable to examination under anesthesia.  A limited amount of scar tissue was debrided, the ACL graft was intact and no other abnormalities were noted.  Following the second surgery the CI continued to have knee pain.  Despite treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left knee pain, status post anterior cruciate ligament reconstruction” for PEB adjudication.  At the MEB NARSUM examination, 31 August 2005, the CI reported pain, especially on the medial aspect of the knee, with swelling due to prolonged standing, lifting, or carrying heavy items.  The physical examination noted tenderness to palpation over the medial femoral condyle; slight medial joint line tenderness without effusion and no evidence of instability.  Knee ROM was flexion of 125 degrees (normal 140) and extension of 0 degrees (normal 0 degrees).  Examination of the lower extremity was normal.

The CI did not file with the VA until 4 years after separation, and failed to report for his C&P examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating coded analogously to 5003 (degenerative arthritis) citing residual pain, slight, frequent.  The VA coded the left knee condition 5259 (Cartilage, semilunar, removal of, symptomatic) but did not service-connect the knee condition (NSC) citing no evidence of a current condition and that the CI failed to report for the C&P examination.  There was no limitation of motion which attained even a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258), to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  Therefore, no change to the PEB’s coding choice is recommended.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.   

 
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20160014798 (PD201500940)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

						         
Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA